What is gout? Gout is a common form of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a substance in the blood that is produced by the breakdown of waste products called purines. If excessive uric acid is produced by the body or if uric acid is not eliminated effectively by the kidneys, it can form deposits of crystals in the joints. Uric acid crystals can cause intense and sudden inflammation, pain, redness, stiffness and burning in and around joints that can persist for several weeks. Gout often starts in one of the big toes, but it can also affect the fingers, wrists, elbows, knees, ankles, heels, and other joint areas. Gout is most commonly seen in men older than age 40, but it can strike anyone, especially postmenopausal women. Pacific Islanders are far more susceptible to gout compared to other ethnic groups. Gout is not curable, but it can be successfully managed with medical therapy and lifestyle changes. Its symptoms resemble those of several other diseases, disorders and conditions, such as psoriatic arthritis and pseudogout. Prompt diagnosis and treatment of gout can help control symptoms and reduce the risk of complications, such as disability. Seek prompt medical care if you have symptoms of gout, such as pain, redness, burning or swelling of a joint. A serious complication of gout is kidney stones. Seek immediate medical care (call 911) if you have symptoms of a kidney stone, such as severe flank or abdominal pain, which may occur with bloody urine, reduced urination, or the inability to urinate. What are the symptoms of gout? Gout is a chronic disease that can cause symptoms in acute stages called attacks or flares. The first attack usually occurs at night and is usually limited to one affected joint. Gout flares can last from days to several weeks. Flares can occur regularly for some people, while for others they may occur every few months or even years apart. Gout flares often include these symptoms in and around joints: Burning or heat Pain Redness Stiffness Swelling Tenderness For many people, gout flares consistently affect a single lower-body joint at a time, such as the big toe, ankle, heel, or knee. Inflammation can also occur in a finger, wrist, elbow, or other joint area. The symptoms can range from mild to severe and often begin in the middle of the night. Left untreated, acute gout flares can result in chronic gout or gouty arthritis. This can cause long-term damage to the joints and kidneys, debilitating joint pain, kidney stones, and painful clusters of uric acid under the skin called tophi. Seek prompt medical care if you have symptoms of gout, such as severe joint pain, swelling, burning or redness. Seek immediate medical care (call 911) if you have symptoms of a kidney stone, such as severe flank or abdominal pain, which may occur with bloody urine, reduced urination, or the inability to urinate. What causes gout? Gout is caused by a metabolic disorder called hyperuricemia. Hyperuricemia is an excessive amount of uric acid in the blood. Uric acid is produced by the breakdown of waste products called purines. Hyperuricemia occurs when there is an overproduction of uric acid by the body or when the kidneys fail to effectively eliminate uric acid through urination. Gout may result as a complication of diuretic use, multiple lyeloma, cyclosporine use, and chronic kidney disease. Excess uric acid can build up and form crystals in and around joints, resulting in gout symptoms, such as inflammation, pain, redness, stiffness, and heat in and around joints. In fact, gout can be diagnosed by examining synovial fluid from the affected joint under a microscope to see if it contains the characteristic uric acid crystals. Although hyperuricemia is a cause of gout, it is not the same as gout. You may have hyperuricemia and not have gout. Gout triggers The following triggers can increase uric acid levels, which may lead to hyperuricemia and gout: Cancer chemotherapy Certain medications, such as diuretics, immunosuppressants (such as cyclosporine), and aspirin Dehydration Foods and beverages containing high levels of purines, including sweetbreads, game meats, alcohol, certain fish and shellfish, and organ meats such as liver and kidney Joint injuries and infections Severe infection or illness Sudden weight loss Surgery What are the risk factors for gout? Research has identified several risk factors that can make you more prone to develop gout. Certain factors can be managed with lifestyle changes; whereas, some risk factors cannot be controlled, such as your family history and certain preexisting diseases. General risk factors for gout Well-accepted risk factors for gout include: Cancer chemotherapy Certain medications, such as diuretics, immunosuppressants (such as cyclosporine), and aspirin Dehydration Diet containing high levels of purines, including sweetbreads, game meats, alcohol, certain fish and shellfish, and organ meats such as liver and kidney Family history of gout Female gender past menopause Male gender older than age 40 Obesity Diseases and disorders that increase the risk of gout Certain diseases, disorders and conditions can increase the risk of gout including: Cardiovascular disease (due to atherosclerosis, or hardening of the arteries, or other causes Diabetes (chronic disease that affects your body’s ability to use sugar for energy) Hypertension (high blood pressure) Hypothyroidism (underactive thyroid) Kidney disease (including any type of kidney problem, such as kidney stones, kidney failure, and kidney anomalies) Leukemia (cancer of the blood or bone marrow) Multiple myeloma Myeloproliferative disorders Sickle cell anemia (inherited disease characterized by abnormally shaped red blood cells that impair the delivery of oxygenated blood throughout the body) Reducing your risk of gout flares or attacks If you have recurring gout flares, your health care provider may suggest these lifestyle changes to help prevent the occurrence of future flares: Decreasing your consumption of high-purine foods and beverages, such as sweetbreads, game meats, alcohol, certain fish and shellfish, and organ meats such as liver and kidney Increasing your water intake Participating in a regular exercise program Reducing excessive stress How is gout treated? Gout is a chronic disease that cannot be cured, but there are several helpful and widely accepted therapies available. The goals of gout treatment include managing the pain of current flares, lessening the severity and frequency of future flares, and preventing the onset of chronic gout. Flare pain management The following medications and therapies are often used to ease the pain and reduce the inflammation of gout flares: Colchicine (Colcrys), which is more effective the closer it is taken to the onset of the flare Cold compresses applied directly to the affected joints Corticosteroids, such as prednisone, taken orally or injected directly into the affected joints Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), or indomethacin (Indocin) Rest Medications used to treat severe gout If you have recurring gout flares and increasingly severe gout symptoms, your health care provider may prescribe medications to lower your uric acid levels, such as: Allopurinol (Lopurin, Zyloprim) Colchicine (Colcrys) in lower doses than are prescribed during a flare Febuxostat (Uloric) Probenecid (Benemid) Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), or indomethacin (Indocin), may also be used in severe gout to treat pain and inflammation. Lifestyle changes that help manage gout Your health care provider may also suggest these lifestyle changes to help prevent gout or the occurrence of future flares: Decrease your consumption of high-purine foods and beverages. Increase your water intake. Maintain a healthy weight. Participate in a regular exercise program. Reduce excessive stress. What are the possible complications of gout? Over time, acute gout flares can evolve into chronic gout or gouty arthritis. This occurs when repeated gout flares cause long-term damage to joints or kidneys, resulting in: Constant and debilitating joint pain Disability Joint deformities and loss of joint mobility Kidney stones Tophi, which are uric acid crystals that clump together and lodge in the tissues around your joints You can help minimize your risk of chronic gout and other complications by following the treatment plan you and your health care provider design specifically for you.